Abstract
BackgroundMost serous ovarian cancers are now understood to originate in the fallopian tubes. Removing the tubes (salpingectomy) likely reduces the risk of developing high‐grade serous ovarian cancer. Numerous gynaecological societies now recommend prophylactic (or opportunistic) salpingectomy at the time of gynaecological surgery in appropriate women, and this is widely done. Salpingectomy at the time of non‐gynaecological surgery has not been explored and may present an opportunity for primary prevention of ovarian cancer.MethodsThis study investigated whether prophylactic salpingectomy with the intention of reducing the risk of developing ovarian cancer would be accepted and could be accomplished at the time of elective laparoscopic cholecystectomy. Women aged at least 45 years scheduled for elective laparoscopic cholecystectomy were recruited. They were counselled and offered prophylactic bilateral salpingectomy at the time of cholecystectomy. Outcome measures were rate of accomplishment of salpingectomy, time and procedural steps needed for salpingectomy, and complications.ResultsA total of 105 patients were included in the study. The rate of acceptance of salpingectomy was approximately 60 per cent. Salpingectomy was performed in 98 of 105 laparoscopic cholecystectomies (93·3 per cent) and not accomplished because of poor visibility or adhesions in seven (6·7 per cent). Median additional operating time was 13 (range 4–45) min. There were no complications attributable to salpingectomy. One patient presented with ovarian cancer 28 months after prophylactic salpingectomy; histological re‐evaluation of the tubes showed a previously undetected, focal serous tubal intraepithelial carcinoma.ConclusionProphylactic salpingectomy can be done during elective laparoscopic cholecystectomy.
Highlights
Serous tubal intraepithelial carcinoma in a patient who developed peritoneal carcinomatosis of a high-grade serous carcinoma 28 months after prophylactic salpingectomy. a The fimbria is partially covered by markedly atypical epithelium ( ), which is highlighted by a mutant immunoreactive pattern for TP53
Age and BMI did not differ between patients who did and those who did not undergo prophylactic salpingectomy
A previous study[31] showed that women aged 45 years or older scheduled for elective laparoscopic cholecystectomy were open to the idea of prophylactic salpingectomy with the intention of preventing ovarian cancer
Summary
Ovarian cancer is the leading cause of death among gynaecological malignancies and the fifth most common cause of cancer death among women in developed countries[1]. Removing the tubes (salpingectomy) likely reduces the risk of developing high-grade serous ovarian cancer. Salpingectomy at the time of non-gynaecological surgery has not been explored and may present an opportunity for primary prevention of ovarian cancer. Methods: This study investigated whether prophylactic salpingectomy with the intention of reducing the risk of developing ovarian cancer would be accepted and could be accomplished at the time of elective laparoscopic cholecystectomy. Women aged at least 45 years scheduled for elective laparoscopic cholecystectomy were recruited. They were counselled and offered prophylactic bilateral salpingectomy at the time of cholecystectomy. One patient presented with ovarian cancer 28 months after prophylactic salpingectomy; histological re-evaluation of the tubes showed a previously undetected, focal serous tubal intraepithelial carcinoma. Conclusion: Prophylactic salpingectomy can be done during elective laparoscopic cholecystectomy
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